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Lasers Lighting Up Crohn's and Colitis

A new kind of laser is lighting the way to better treatment for some autoimmune diseases.

One-point-five million Americans suffer with IBD’s—inflammatory bowel diseases—like Crohn’s and ulcerative colitis. Treatment for these autoimmune diseases can leave patients at risk for infection and even cancer. For IBD patients, screening for cancer has meant repeated colonoscopies and tissue biopsies—as many as a dozen a year. The annual cost for this in the U.S. is over a billion dollars. Now, a new laser could cut costs and the number of patient procedures.
The laser micro endoscopy has a tiny blue light. It is a small but powerful microscope for navigating the intestines.
With just a touch of the probe anywhere on the intestine wall, Dr. R?zvan Arsenescu can magnify tissue a thousand times, spotting even the earliest abnormal cells.
The Ohio State University’s Wexner Medical Center is one of the first hospitals in the country to use it. Before this laser, doctors had to depend on taking random tissue samples.  He says it was like stumbling around a huge dark room trying to find a needle.
“Whereas now, if I find something, I can act on the spot,” R?zvan I. Arsenescu, MD, PhD, Associate Professor, Director, Inflammatory Bowel Diseases Center, Division of Gastroenterology Hepatology and Nutrition, The Ohio State University Wexner Medical Center, told Ivanhoe.
Good news for Ben Buss, whose Crohn’s disease has meant a new diet, medication, six colonoscopies in two years, and a surgery to remove part of his small intestine.
Ben had a recent probe that showed some suspicious cells.  Without the new laser these could have been missed.
“Anytime you're able to diagnose earlier things that might be particularly life-threatening like cancer, that's a great thing,” Ben Buss told Ivanhoe.
It’s a small light making a big difference in a deadly disease. 
Doctors hope that eventually the laser micro endoscopy will be used to guide treatment not only for IBD sufferers, but also patients with lung, bladder, and gynecologic diseases.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic intemperate of all of the organs in your digestive tract. It currently affects close to 1.5 million Americans. IBD usually includes Crohn’s disease and ulcerative colitis, and can be very painful and uncomfortable. Crohn’s disease causes inflammation in the digestive tract and spreads along the tissue. The effects are severe diarrhea, malnutrition, and abdominal pain. Ulcerative colitis is another inflammatory bowel disease that is long-lasting. The symptoms of this disease develop over time, but it only affects the lining of the large intestine. (Source: http://www.mayoclinic.com/health/inflammatory-bowel-disease/DS01195)
SYMPTOMS: Symptoms of IBD may vary between each patient, but they typically include:
* Fever
* Loss of appetite
* Weight loss
* Diarrhea
* Blood in stool
* Urgency to have a bowel movement
* Abdominal cramps
* Iron deficiency
(Source: http://www.cdc.gov/ibd/)

NEW TECHNOLOGY: A new laser micro endoscopy is helping doctors treat patients with IBD more effectively. Whereas before, patients would undergo numerous colonoscopies and biopsies, the laser micro endoscopy can determine which areas need to be biopsied. It allows doctors to simply touch the endoscopy to a part of the intestine, and examine tissue with 1,000 times magnification. In real-time doctors can then determine if the tissue needs to be biopsied. Over 100 patients have already received the treatment, and the hope is the endoscopy could be used to treat lung, bladder, or gynecologic diseases in the future. (Source: http://osuwmc.multimedianewsroom.tv/story.php?id=660&enter=#downloadsarea)
FOR MORE INFORMATION, PLEASE CONTACT:

Becky Crader
Coordinator Administration
OSU Inflammatory Bowel Diseases Center
(614) 366-4925
Rebecca.Crader@osumc.edu



R?zvan I. Arsenescu, MD, PhD, Associate Professor, Director, Inflammatory Bowel Diseases Center, Division of Gastroenterology Hepatology and Nutrition, The Ohio State University Wexner Medical Center, talks about a new technology for Crohn’s disease and colitis.
Can you tell us about your new device?
Dr. Arsenescu: This is a FDA approved device. The majority of physicians now are targeting the upper part of the gastrointestinal tract. So, it could be used on conditions like cancers of the esophageal area.
We talked to one of your patients, can you tell me about his story?
Dr. Arsenescu: He has a heart and valve disease for a number of years and he has received medications to control inflammation. Unfortunately, in patients that have disease for a longer time there is a change in the lining of the gut where it becomes more like cancer and often times dying of the cancer infection.  Infection is very difficult to treat because in a typical case of sporadic colon cancer, in which you have sequence or polyps have grown over several years, and then it takes several more years for the polyps to become cancer. Where as in IBD, often times it’s a normal appearing lining that you go through the endoscope. The cancers tend to grow the opposite side not necessarily forming a polyp. So, what most of the physicians do now is randomly take biopsies throughout the colon, which is a long tube. Obviously, by doing so you’re mostly investigating point zero one percent of the entire colon. It’s almost nothing technically right, but it’s like being in a dark room and it’s huge to ask you to find a needle there just by fumbling around. So, with this technology we are able to probe a much larger surface; probably ten times more than by doing biopsies. By doing so, by investigating a larger surface, you’re more likely to find something. On the other hand by focusing your biopsy in areas that are suspicious for precancerous lesions, then your yield is higher so a way you can reduce the number of biopsies and reduce the of risks of the biopsies while increasing your yield of diagnosis.
So, is it faster?
Dr. Arsenescu: It is faster. Also, it saves money by avoiding other procedures or getting most of the answers in that session.
How will this laser help patients?
Dr. Arsenescu:  So, one way in which it will help is it may allow us to detect cancers in a better way. It may allow us to reduce the number of biopsies when you’re doing the procedure, so it may impact the risk associated with doing more biopsies. It may also allow us to access the responsive therapy and this is a new emerging field now so we haven’t quite figured out the impact with regards to the therapy as far as some extra medication or monitoring them, but I see great value to future studies to actually incorporate this as a tool to give a prognosis to decide who has to be on a certain combination of medications or who has to be on less medication. 
How many people does this impact?
Dr. Arsenescu: So, currently there are nearly one million people in the country that are impacted by inflammatory bowel diseases. We estimate that the incidence of cancer over time is anywhere from one to five percent depending on the study. However, it’s quite a large number.
So how long is the procedure with the laser?
Dr. Arsenescu:  Not as long, depending on for what indication. If it’s for a screening procedure that requires screening for cancer, it may add about ten minutes to the procedure, to perform the laser procedure. However, doing biopsies randomly for the colon actually requires quite a lot of time. So when comparing the two methods, I think as we develop new protocols and gain more knowledge and develop the optimal way to do it, we may end up actually saving time with getting more information regarding the risk of cancer for the patients.
Can you tell us how the procedure is performed?
Dr. Arsenescu: So, we rely on a yellow dye called florescence, this has been long used by ophthalmologist physicians to examine if something is going on in the eye. This dye relies on a certain wave length, but it’s by the laser. So, the laser basically identifies the presence of this dye in the lining of the colon. By doing so, you are going to get a black and white image yet its contrast allows you to distinguish structures so you can see cells, you can see organized cells in glands, which are part of the normal anatomy. You can see blood vessels and individual blood cells moving through.
Is this like an X-ray?
Dr. Arsenescu: This is not an x-ray. A light is emitted by a chemical compound through the laser.
Who are good candidates for this procedure?
Dr. Arsenescu: I think if anybody has had colitis for about eight years or Crohn’s disease for about ten years and where we have an indication to do a screen for cancer or even earlier in patients that have an association with IBD and a liver condition, they have much higher risk of cancer and this would be a prime candidate. 


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